Concurrent Speakers

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Rosalie Schultz
Climate change and health in rural Australia
Biography

Rosalie Schultz studied medicine in Perth before it was a big city. She discovered rural and remote health and a thirst to understand Aboriginal knowledge early in her career and has not looked back. Her experience and expertise cover public health and clinical aspects of communicable and non-communicable disease; injury prevention and safety promotion; cultural safety, white privilege and racism; and community development. As a rural GP and public health physician, Rosalie recognises climate change is the greatest threat to health, and is already increasing morbidity and mortality from communicable and non-communicable disease and injury, and mental health issues. Her research in rural Australia explores the knowledge and wisdom of Aboriginal Australians, and opportunities for two-way learning that recognises and builds on Aboriginal expertise. Incorporating both forms of knowledge and tools into climate change mitigation and adaptation provides opportunities for more sustainable development both in Australia and globally.

Abstract

The health effects of climate change are evident today, with rural Australia particularly vulnerable owing to increasing extreme heat and bushfires, changed rainfall patterns and challenges to livelihoods. Future climate projections represent a major threat to public health in Australia and worldwide. However, tackling climate change offers significant opportunities for improvements in health (Watts et al, 2015). Rural health professionals are optimally placed to be at the forefront of this change.

Recognition of the social and environmental determinants of health is an essential foundation of healthcare. It is crucial that Australian health professionals are aware and empowered to integrate climate and health considerations into their professional practice. Health professionals’ respected position in the community empowers us to offer leadership in climate change mitigation by reducing carbon emissions, and to advocate for policies which safeguard and promote a healthy, sustainable Australia.

This workshop will offer health professionals an evidence-based overview of the health impacts of climate change with a focus on those relevant to rural communities in Australia and vulnerable populations including the elderly, children and those with chronic diseases. It will then lead into a discussion around the unique role of health professionals in advocacy, awareness and community engagement, and provide some tools and direction to further develop these skills. The workshop will cater for a range of knowledge bases, and is recommended for those wishing to further their expertise and agency in tackling this public health issue.

Paper
Rosalie Schultz
Ecological determinants of health
Biography

Rosalie Schultz is a member the NT Branch and Environment and Ecology Special Interest Group of the Public Health Association of Australia, as well as a member of Doctors for the Environment Australia and affiliated with the Centre for Remote Health, Flinders University. Rosalie studied medicine in Perth, then discovered the attractions of rural and remote health practice, and interest in Aboriginal people and their knowledge and ways of knowing. Her experience and expertise include clinical and public health aspects of communicable and non-communicable disease; injury prevention and safety promotion; cultural safety, white privilege and racism; community development, ecohealth, one health and planetary health. As a rural GP and public health physician, Rosalie recognises climate change is the greatest threat to health and is already increasing morbidity and mortality from communicable and non-communicable disease and injury, and mental health issues. Rosalie’s research in rural Australia explores the knowledge and wisdom of Aboriginal Australians, and opportunities for two way learning that recognise and build on Aboriginal expertise, particularly in caring for Country. She is interested in promoting health and wellbeing based on ecological knowledge, and appreciating and responding to ecological grief.

Abstract

Social determinants of health are widely acknowledged, particularly in efforts to respond to the health status of Indigenous Australians. We await comparable recognition of ecological determinants of health, despite long-standing calls from Indigenous Australians whose health includes their Country.

WHO social determinants of health highlight social inclusion, early childhood, education, employment, housing, and access to health care, and mention ecological determinants of health within discussion of urbanisation. Health promotion as defined in the Ottawa Charter acknowledges ecological determinants, yet its strategies comprise policy action, community development, personal skills, and re-orienting health services. Creating supportive environments could refer to ecological environments but is usually associated with policy and economic environments rather than the ecological environments that sustain us.

Ecological determinants of health appear to be taken for granted, leaving them inadequately recognised and understood. They are often seen as being outside the scope of health research and practice, even in health promotion and disease prevention.

In 2015, 193 countries including Australia committed to 17 Sustainable Development Goals (SDGs) in the United Nations Agenda 2030, a bold shared blueprint for peace and prosperity for people and the planet. The SDGs are an urgent call for both developed and developing countries to partner in sustainable development. The SDGs recognize that ending poverty and deprivation requires reducing inequality, improving health and education, and attention to ecological determinants of health. Unlike previous global development aspirations, the SDGs require rich countries to account for their own patterns of development, and ecological aspects cannot be overlooked.

Australia reports on our response to the SDGs though the Department of Foreign Affairs and Trade. Our absolute and relative performances are declining, from 18th in 2015 to 37th in 2018. We do particularly poorly in goal 2 on ending hunger because high levels of fertiliser inputs make our agriculture unsustainable; goal 7 affordable clean energy, with our high and increasing CO2 emissions; goal 10 inequalities; goal 12 responsible production and consumption; goal 13 climate action; goals 14 and 15 land and ocean biodiversity; and goal 17 international partnerships. A miserable performance: even in health Australia is under-performing because of inequality of health outcomes.

Australia’s deteriorating SDG performance requires attention to ecological determinants of health and wellbeing, and to the knowledge, wisdom and aspirations of Indigenous Australians, who suffer most from our poor development trajectory yet represent the contemporaries of the most enduring cultures.

Presentation | Paper
Kelly Schulze

First-time presenters First-time presenters

Working together to build sustainable cancer services close to home
Biography

Ms Kelly Schulze holds academic qualification in occupational therapy and has worked in the university environment, as well as in clinical positions. She has held a number of project management and strategic policy and advisory positions in SA Health and Country Health SA Local Health Network, including as Rural Clinical Placements Project Manager, Senior Clinical Educator, Advanced Clinical Lead Occupational Therapist and Senior Workforce Consultant. In her current role as Manager, Cancer Services, her role is to ensure that the Country Health SA Local Health Network is delivering high-quality, safe and sustainable cancer services to residents of country South Australia.

Abstract

“After being diagnosed with Ovarian Cancer in July 2017 our lives seem to revolve around Doctors and Specialist Appointments, scans and treatments. Being able to access treatment and services (closer to home) has made life so much easier and greatly reduced our stress levels.” Consumer feedback.

Since 1982, cancer incidence in Australia has increased from approximately 47,000 cases to approximately 128,000 in 2014*. Additionally, in 2008-2012 age-standardised incidence rates were higher in remote and very remote areas combined, compared to major cities for some cancers*. Between 1984–1988 and 2009–2013, 5-year relative survival for all cancers combined increased from 48% to 68% (AIHW 2017). Given increased incidence in cancer, particularly in rural areas it is imperative that access to multi-disciplinary treatment is maximised in rural areas. Furthermore, treatment for some cancer patients is sustained over a long-term, therefore increased access to treatment options is vital to reduce the burden of disease and increase acceptance of treatment and resultant survivorship. In many cases, cancer is a chronic illness requiring ongoing management over many years.

South Australia’s Country Cancer Services are an integral part of the state wide cancer service, providing essential access to treatment outside of metropolitan hospitals and facilitating care closer to home for many country patients. The Country Cancer Service was created through 2010 State and Federal funding. Chemotherapy activity over this time has significantly increased with a 70% increase reported in the last six years across the country units.

While Country Cancer Services has developed a satisfactory specialist service delivery model, challenges were emerging that could compromise sustainability of the service. Demand for service within the three moderate complexity units at Whyalla, Mount Gambier and Port Pirie is consistently high whilst some low complexity units experience under-utilisation. Other challenges include current funding systems, single clinician risks and access for Aboriginal consumers.

It was time to consider barriers to the sustainability, further growth and maturity of Country Cancer Services. A process was commissioned to closely examine Country Cancer Services. 14 recommendations were provided to improve the sustainability and impact of Country Cancer Services, relating to:

  • funding
  • staffing
  • care of Aboriginal patients
  • complexity level of chemotherapy units
  • chemotherapy prescribing and pharmacy
  • referral and flow
  • links with metropolitan units
  • access for private patients.

Country Cancer Services is partnering with consumers, country GP’s, SA Medical Research Institute and metropolitan cancer services to ensure sustainability of cancer services for country patients into the future. This paper will illustrate the impact of this service review and improvement for rural South Australians by reporting on qualitative and quantitative improvements implemented and planned including:

  • improved funding for chemotherapy provided in country South Australia
  • investment in specialist staff
  • partnerships with metropolitan cancer services to build unit capability
  • implementation of a multi-purpose unit model at low complexity chemotherapy units
  • Aboriginal Healing Centre Trial.

Recent service improvements have already enabled greater access to chemotherapy treatment closer to home for country patients with a 24% increase in chemotherapy treatment delivered in Whyalla and Mount Gambier chemotherapy units over the past two months.

Presentation | Paper
Courtney Schuurman

First-time presenters First-time presenters

Child mental health is everyone's responsibility
Biography

Courtney Schuurman is a senior child mental health workforce consultant in Victoria and Tasmania. She is a qualified social worker with over 10 years of experience working in a range of settings from the acute hospital system, migrant and refugee services and integrated family services. As a result, she has significant experience with high risk, vulnerable infants and their families as a practitioner, mentor and manager in programs with urban, outer urban and rural reach. Since graduating with her Bachelor of Social Work, Courtney has completed postgraduate studies in child and family practice, neurosequential model of clinical problem solving (trauma-informed practice) and infant mental health.

Abstract

There has been a gradual recognition across the service system that we need to better our understanding and commitment to infant and child mental health. However, we are not there yet. A focus on infant and child mental health needs to be strengthened across all health service systems, and we need to commit ourselves to a high emphasis on supporting this in the early years. This commitment is required from all professionals, organisations and peak bodies regardless of whether your work is adult focused or child-focused.

The National Workforce Centre for Child Mental Health (NWCCMH) led by Emerging Minds and delivered in partnership with The Australian Institute of Family Studies, Parenting Research Centre, The Australian National University and the Royal Australian College of General Practice has been funded by the Commonwealth Government to change this picture. Professionals, organisations and peak bodies working with children aged 0–12 years, with adults who are parents or carers, or with families, have a crucial role to play in strengthening infant’s and children’s social and emotional wellbeing and recognising when a child may be at risk of developing mental health difficulties. The NWCCMH is committed to supporting infants and children across Australia and acknowledge the different challenges that rural and remote services have and more so the different challenges infants, children and families have within these communities. By partnering with the NWCCMH, rural and remote families, communities, practitioners and sectors can advance the social and emotional well-being of infants and children. This is particularly pertinent considering evidence on the impact of intergenerational vulnerabilities such as poverty, drug and alcohol issues, and domestic and family violence on infants and children.

This 20-minute presentation will look at ways the NWCCMH can provide support to professionals and organisations in rural and remote settings to increase awareness of infant and child mental health, and support practitioners’ skills and confidence in identification, prevention and early intervention. Our team of consultants will work alongside practitioners, organisations, alliance partnerships and peak bodies to support the workforce, and practice development, organisational and systems change and continuous quality improvement because child mental health is everyone's responsibility.

Presentation | Paper
Angela Scuderi

First-time presenters First-time presenters

Child mental health is everyone's responsibility
Biography

Angela Scuderi is an accredited mental health social worker with over 18 years of experience working with vulnerable children and families in a range of community settings from mental health, family services, trauma, grief and bereavement. She has worked in the outer urban catchments of north-eastern Melbourne as well as rural communities affected by the 2009 Victorian Bushfires. Her approach is trauma informed, strengths based and person centred. She is also a certified bereavement counsellor, child centred play therapist and trained in eye movement desensitisation and reprocessing (EMDR). She also has over 10 years' experience as an educator and trainer in the TAFE and private systems. She is currently completing a Master of Counselling and Psychotherapy.

Abstract

There has been a gradual recognition across the service system that we need to better our understanding and commitment to infant and child mental health. However, we are not there yet. A focus on infant and child mental health needs to be strengthened across all health service systems, and we need to commit ourselves to a high emphasis on supporting this in the early years. This commitment is required from all professionals, organisations and peak bodies regardless of whether your work is adult focused or child-focused.

The National Workforce Centre for Child Mental Health (NWCCMH) led by Emerging Minds and delivered in partnership with The Australian Institute of Family Studies, Parenting Research Centre, The Australian National University and the Royal Australian College of General Practice has been funded by the Commonwealth Government to change this picture. Professionals, organisations and peak bodies working with children aged 0–12 years, with adults who are parents or carers, or with families, have a crucial role to play in strengthening infant’s and children’s social and emotional wellbeing and recognising when a child may be at risk of developing mental health difficulties. The NWCCMH is committed to supporting infants and children across Australia and acknowledge the different challenges that rural and remote services have and more so the different challenges infants, children and families have within these communities. By partnering with the NWCCMH, rural and remote families, communities, practitioners and sectors can advance the social and emotional well-being of infants and children. This is particularly pertinent considering evidence on the impact of intergenerational vulnerabilities such as poverty, drug and alcohol issues, and domestic and family violence on infants and children.

This 20-minute presentation will look at ways the NWCCMH can provide support to professionals and organisations in rural and remote settings to increase awareness of infant and child mental health, and support practitioners’ skills and confidence in identification, prevention and early intervention. Our team of consultants will work alongside practitioners, organisations, alliance partnerships and peak bodies to support the workforce, and practice development, organisational and systems change and continuous quality improvement because child mental health is everyone's responsibility.

Presentation | Paper
Catherine Sefton
Getting GPs into residential aged care: time for a rethink on remuneration?
Biography

Dr Cath Sefton is a senior consultant with KBC Australia a public policy consulting firm with specific expertise in rural and remote needs assessment, program and service planning and evaluations in regional and rural areas. Cath has a background in public health and the public sector, and in recent years has participated and led a variety of consulting projects for KBC, including evaluations, policy development and program reviews. Cath has considerable experience in the design, conduct and management of research and evaluation projects and has participated in a variety of health service planning, workforce analysis and needs assessments.

Abstract

There is some evidence and a common perception that GPs are increasingly reluctant to provide care in residential aged care facilities (RACFs). Barriers identified in previous studies include high out of hours demands, poor interoperability of systems requiring considerable duplication of record keeping, cumbersome communication methods, high volume of unremunerated work including travel and inadequate remuneration to meet the needs of residents with complex health needs.

A recent evaluation of a pilot of GP video conferencing into RACFs reinforced these concerns. GPs described the high volume of communication they received from RACFs including multiple faxes, emails and telephone calls on any given day requesting medication changes, script renewals or pathology requests, each requiring time to locate and update records and respond. Similarly, GPs highlighted the amount of time spent on duplicating and updating practice records following face to face visits to facilities. These small tasks can compound, resulting in considerable time spent on activities for which the GP is unable to claim remuneration, either from Medicare or directly from patients. Further, a considerable proportion of the activity undertaken in the provision of GP care in RACFs does not directly involve the resident and therefore does not fit within the fee for service model.

GPs’ capacity to provide comprehensive care is often limited by their need to visit facilities after or before the usual practice opening hours, reducing opportunities to engage with regular RACF nursing staff and limiting access to practice tools and supports such as practice nurses.

There was considerable commonality in these issues between both urban and rural areas.

Health Care Homes are being trialled as a mechanism to fund and facilitate optimal care for people with chronic disease using a bundled payment arrangement to enable flexibility in how care is delivered. It recognises the limitations of fee for service models where complex and ongoing care is required.

Which leads us to ask: Could a similar approach be adopted for remunerating primary health care in RACFs?

A bundled payment for care of a RACF resident based on an assessment of level of need/complexity could factor in regular communication between the RACF and the practice, the added time involved in providing care offsite from the clinic setting and encourage better integration with general practice systems.

Presentation | Paper
Merridee Seiboth

First-time presenters First-time presenters

The community and health service working together to grow the local workforce
Biography

Merridee Seiboth has over 40 years’ experience in the nursing and midwifery professions, mostly full time, working predominantly in a rural environment. Currently Merridee is the Director of Nursing & Midwifery at the Loxton Hospital Complex SA. The health service, well supported by the local community, is a 22-bed acute facility and has a co-located home for 58 residents in aged care. Over the years she has worked on many SA country-wide projects, most recently a 'second reviewer' concept when there is not a second midwife available onsite for hourly CTG reviews. Merridee believes a rural environment brings the best opportunities to experience nursing and midwifery over the entire spectrum of life, sharing experiences with community members during births, illnesses and, importantly, as they pass. Having raised six children and currently a carer for an elderly mother suffering dementia, also allows her to have a greater understanding of the needs of the people in her community. With ever-increasing difficulties in recruiting staff to rural areas, Merridee is conscious of the need to explore innovative opportunities to encourage people to take up employment in the region and to support those who are often practising in isolation from colleagues.

Abstract

Attracting and retaining well trained direct care workers to support people living in residential care and those who are on support packages in their homes, is an increasing challenge in many rural health services. In the Riverland of South Australia, the community and the local health service have come together to meet this challenge in a very innovative way.

The local Health Advisory Council (HAC)—a group of community members responsible for managing the assets and fundraising of our health service- resolved to offer scholarships to our local residents to gain Certificate III Personal Support (Ageing and Home & Community). We hoped to provide an incentive to attract the right person to undertake the training, with a nationally registered training program and our health service oversight of the students. We wished ensure a steady supply of appropriately trained people from our community to meet our workforce needs—both within the residential facility and the community and develop this into the ‘transition of care’ for our community members moving in to a residential facility? Most importantly, we wished to have the students trained on site in our hospital complex, and in collaboration with our local health and community services, using a high quality Registered Training Organisation (RTO).

A process was put in place to seek expressions of interest from RTOs to provide the training. Theoretical training was to take place on site, enabling students to work with local equipment and work placements undertaken within the residential home and local community. Local staff were able to provide input into the curriculum to ensure the content included aspects important to our local needs and the future direction of consumer driven care.

Criteria was established for the scholarship application process and interviews held to select successful candidates. Training for the inaugural group commenced on site, in July 2018. The students complete the course by December and their success will drive this concept into the future.

Importantly, the trial will inform the continuation and expansion of this initiative in the region, but it can also inform state and national workforce policy to support local ‘grow your own’ sustainable, fit-for-context workforce solutions in partnership with community.

Focusing on a continuity of care model, this initiative will create employment opportunities for appropriately trained workers to support the elderly people who are transitioning from home to residential care. This program is an excellent example of how the community, the local hospital service, community health service and Local Health Network (LHN) are working ‘better together’ to create an employment pathway designed to meet the needs of our community.

Paper
Katie Senior

Arts in health Arts in health

The Extra Some
Biography

Katie Senior is an extraordinary 27 year old with Down syndrome. She has been dancing and performing since age five and represents Australia as a paralympic swimmer. She has choreographed and performed two solos since 2010: All For One was performed at Belconnen Art Centre to celebrate International Day of People with Disability in 2011 and In The Corner Where The Shadows Meet was for 'Short and Sweet Dance.' It was Katie's first choreographic and dance mentorship project with Liz Lea was funded through the Jump! program. Katie is also an actress. She is a member of Rebus Mixed Ability Theatre Company and was lead actress in Beautiful, a movie directed by Genevieve Clay and produced in Canberra. Beautiful featured in the Other Film Festival in 2012. She is currently working with Rebus Theatre and was the 2017 ACT Dance Artist of the Year.

Abstract

What does it mean to have an extra chromosome? Dance artist Katie Senior and Liz Lea takes you on a journey of life, love, laughter and walks in nature—in fabulous style.

Presentation
Ayman Shenouda
The role of rural health teams in addressing drought
Biography

A/Prof Ayman Shenouda has been the Chair of RACGP Rural since October 2014; prior to that he was the deputy chair for five years. Ayman is the Vice-President of the RACPGP Board as of October 2018. Ayman is also a member of the RACGP NSW&ACT Council Executive and was on the RACGP National Standard Committee of Education for several years. Ayman was awarded RACGP GP of the Year in 2009. His practice was awarded NSW&ACT General Practice of the Year in 2007. Ayman migrated to Australia 22 years ago from Egypt. He commenced his medical career in Australia as a surgical registrar in Tasmania in 1995, and has been a rural GP in Wagga Wagga for the last 17 years, where he established Glenrock Country Practice. Ayman’s main interest is education and training and his passion is to develop quality frameworks and systematic management tools to enable and enhance the work of GPs.

Abstract

We are seeing a major drought, particularly in the worst-affected parts of NSW where the current dry conditions have spread to most inland parts of the state.

The recent media focus is a good thing to keep some philanthropic and government dollars flowing, but we really need a better preventative strategy to protect our farmers and our food resources from these extremes.

What we are seeing is reactive policy which only demonstrates the ineffectiveness of our national drought management policies.

While short-term drought-related health shocks can be more obvious, it is those longer term, more indirect health implications that are harder to measure and monitor.

In helping our communities prepare for drought, rural health teams should develop drought-related public health vulnerability assessments. This involves rural health teams working with the community and key partners to ensure coordinated preparedness and response efforts. Staying engaged through non-drought periods is essential.

This presentation will focus on strategies for rural health teams in reaching out to drought-affected farms and outline the key steps to consider in undertaking drought planning and vulnerability assessment in rural communities.

Presentation | Paper
Jennifer Smith
Better or worse? Returning children with complex health needs to their communities
Biography

Dr Jennifer Smith is a Senior Lecturer in Social Work who has worked for 35 years in the area of child protection and domestic violence. Her publications mainly focus on the impact of domestic violence on children and women. From 2014 to 2018 she managed the two largest Child Safety Offices in Queensland (Rockhampton and Toowommba South), both of which covered large geographical rural areas. Prior to that she worked in the non-government sector, overseeing intensive family support programs as the State Manager for Practice, UnitingCare Community for four years. She was also the Director of the Child Advocacy Service at the Royal Childrens Hospital in Brisbane from 1999 to 2005. Jennifer has a strong interest in the health needs of children in foster care and established a specialist clinic for children in foster care while at the RCH. She was a recipient of a Creswick Fellowship in Child and Family Development in 2002 and spent time at the Denver Children's Hospital, Kempe Center and the National Center for Shaken Baby Syndrome at the Primary Children's Hospital in Salt Lake City.

Abstract

Children who are placed in out-of-home care have experienced abuse and/or neglect and as a result may have a history of trauma, attachment disorders, intellectual disability, poor physical, mental and dental health, self-harming behaviours and/or substance misuse. The philosophical approach to child protection practice gives preference to family reunification to either parents or kin for these children where possible. The significant shortage of foster carers, particularly the shortage of Indigenous foster carers for Indigenous children, combined with the need to prevent another Stolen Generation, has resulted in greater attempts to return these children to their kin. The increased recognition of Indigenous perspectives on health and well-being that involve not just physical health but connection to Country and the environment, connection to family and community, sense of Indigenous identity and culture is also necessitating more than just a medical focus on the needs of these children. However, reunification of Indigenous children often means they are being returned to their kin in rural and remote communities where there are scarce health services. This situation presents many difficulties for kin carers particularly those who are caring for children with a disability and those whose psychosocial adjustment has been detrimentally affected by cumulative harm as a result of further abuse while in care. Many of these children have been previously placed with carers in regional towns where there has been access to specialist health services. It these very services which sometimes object to children being moved to live with kin out of a concern about whether adequate medical follow care will be available. This paper will present two case studies which identify some of the complexities of meeting the health care needs of children returned to kin in rural and remote communities along with some suggestions for how these children’s wellbeing can be better monitored.

Presentation
Tony Smith
Sharing limited licence radiography online course material across State boundaries
Biography

Tony Smith is a radiographer with many years’ experience in public hospitals, private practices and the tertiary education sector. Since 2003, he has been employed at the University of Newcastle Department of Rural Health, initially in Tamworth and since 2012 in Taree, on the Mid-North Coast of NSW. He is the Academic Lead – Research in that Department, which supports students from various health professions on long-term and short-term rural placements. Research interests focus largely on rural health workforce issues, especially around the development of new models of interprofessional and collaborative practice, particularly in medical imaging. He has a long-term interest in the education and support of GPs and nurses who perform limited-licence radiography in rural and remote locations, where no radiographer is available.

Abstract

Aim: In rural and remote locations where there is no radiographer available, rural GPs, nurses and other health service personnel can be trained to perform a limited range of plain radiography examinations. While it is a role that exists in all Australian States, it is governed on a State-by-State basis by different licensing authorities, rather than on a national basis. It is subject to different licensing conditions and is inclusive and exclusive of different examination types. Until recently, every State had a separate and unique course; however, course providers in New South Wales (NSW) and Queensland have collaborated to use the same basic radiography, online course material. The aim was to share knowledge and resources, reducing the need for duplication.

Methods: In 2016, an intellectual property agreement was signed between the University of Newcastle Department of Rural Health (UONDRH) in NSW and the Cunningham Centre in Queensland. The parties agreed to share the use of online course material previously developed by the UONDRH under consecutive Rural Health Continuing Education (RHCE) Grants. That material is now stored on a Moodle platform by the Cunningham Centre and accessible to limited licence radiography course participants in each State.

Relevance: This collaboration has a number of implications.

  • It demonstrates that each jurisdiction does not have to duplicate educational resources unnecessarily and that sharing resources across State boundaries is a feasible solution to inter-jurisdictional educational challenges.
  • It also highlights the potential for educational collaboration to lead the way in doing away with unproductive or potentially obstructive differences in State-based legislation in this, as well as in other fields.

Results: The two course providers now share access to seven online course modules, which introduce course participants to the basic physical principles of radiographic imaging, develop their appreciation of radiation safety and explain the clinical practice fundamentals of radiography of the upper and lower limbs and the chest. As well as the online modules, course participants also receive a positioning manual in hardcopy, which is designed to be their radiographic guide and companion. Up to the end of 2018, 84 course participants had used the online education platform and materials.

Conclusion: This collaboration has been marked by a sense of collegiality between the partner organisations, demonstrating willingness to overcome legislative and professional practice variation. It is hoped that other educators in this field in other jurisdictions might consider the value of further collaborative arrangements in the future.

Presentation | Paper
Kim Snowball
Have your say in how the Medical Research Future Fund can transform rural health outcomes
Biography

Kim Snowball has worked in senior health roles in both the public and private health sectors for over 30 years. He has managed and run rural public and private hospitals, led corporate reform of financial and health workforce functions and led the WA Health system as Director General for over three years. In broader national roles, Mr Snowball was appointed Chair of the Australian Health Ministers’ Advisory Council (AHMAC) for two years, a body providing advice and support to Health Ministers and the Australian Health Workforce Ministerial Council (AHWMC). In 2014 Mr Snowball was asked to undertake an independent review of the National Registration and Accreditation Scheme for over 600,000 health professionals for the Australian Health Ministers. A final report was finalised and released by Health Ministers in August 2015. Mr Snowball has a proven track record in the public and private health sector at the senior most levels. He has a deep understanding of the Australian health system and most recently has focused his attention and effort towards innovative clinical service approaches and workforce reform initiatives that will position the Australian health system to better meet the emerging health and service challenges.

Abstract

Clinicians, researchers and community representatives are encouraged to attend this workshop and assist the Alliance to develop its rural research priorities and explore ways of ensuring effective translation of research outcomes from the MRFF have clear benefits for rural Australians.

The $20bn Medical Research Future Fund has been launched with $1.6bn expected to be spent in the first five years.

The program has some unique features that hold significant promise for transforming the health of rural and remote communities.

The key stated aim is through strategic investment to transform health and medical research and innovation to improve lives, build the economy and contribute to health system sustainability.

The underpinning principles are clearly geared to ensuring the fund is responsive to unmet health needs and promoting national focus and collaboration. Translation of the research for patient and community benefit is clearly a key requirement.

The opportunity exists to clarify the importance of effective engagement through MRFF and the research bodies to ensure the 7 million people living in rural Australia benefit. 

In this process the role of the National Rural Health Alliance would seem pivotal.

The engagement needs to be able to:

  • Provide a clear understanding of the major research questions and priorities for rural and remote communities. The Alliance is in a unique position to facilitate and describe these priorities to both the MRFF and participating Universities and Institutions.
  • Articulate and potentially develop a pathway in both the design of the research and in the translation of the research into rural and remote health settings and practice.
  • Ensure that all of the research undertaken through the MRFF includes a thread involving consideration of rural and remote health and communities.

The MRFF and the NRHA are already engaged through formal consultative processes and some part of these questions are already receiving a degree of attention.

Presentation
Kim Snowball
Can technology fix the failure of Medicare for rural and remote Australians
Biography

Kim Snowball has worked in senior health roles in both the public and private health sectors for over 30 years. He has managed and run rural public and private hospitals, led corporate reform of financial and health workforce functions and led the WA Health system as Director General for over three years. In broader national roles, Mr Snowball was appointed Chair of the Australian Health Ministers’ Advisory Council (AHMAC) for two years, a body providing advice and support to Health Ministers and the Australian Health Workforce Ministerial Council (AHWMC). In 2014 Mr Snowball was asked to undertake an independent review of the National Registration and Accreditation Scheme for over 600,000 health professionals for the Australian Health Ministers. A final report was finalised and released by Health Ministers in August 2015. Mr Snowball has a proven track record in the public and private health sector at the senior most levels. He has a deep understanding of the Australian health system and most recently has focused his attention and effort towards innovative clinical service approaches and workforce reform initiatives that will position the Australian health system to better meet the emerging health and service challenges.

Abstract

This presentation will focus on the data, showing the poorer access to Medicare for Australians living in rural and remote areas.

The evidence reinforces a statement by the outgoing Federal Health Minister Dr Michael Wooldridge, in the 2000s that in his view Medicare had failed rural Australia.

The presentation will use Medicare data (non-referred attendances-effectively GP consultations) across the Australian Standard Geographic Classification which allows for quantitative comparisons between ‘City’ and ‘Country’.

The presentation will focus on the population share of Medicare across very remote, remote and outer regional and compare it to major cities. This will show whether Medicare access for rural Australians has improved or continues to be a failure.

The difference in access will be described in dollar terms for each of the geographic classifications.

The presentation will then overlay the burden of disease, preventable admissions and the higher health risks faced by those living in these areas. These health issues are all preventable and treatable with early access, response and advocacy by primary health care services.

It seems strange that those in Australia who are sickest and with high health risks have the least access to Medicare, simply because of where they live. This was once excusable on the basis that it was difficult to get general practitioners into the remote and small rural communities. That excuse has now gone with access to technology.

The presentation will show the evidence that health outcomes in rural and remote Australia would be transformed by a simple act of allowing general practitioners to provide Medicare-funded services through telehealth.

Patients of specialists of all types, including FACEMS, radiologists and psychiatrists, all enjoy Medicare rebates for telehealth consultations. This shows safety and quality are not a barrier to using technology.

Supporting general practitioners through the same access for their patients in remote Australia and in those areas where there is no general practitioner service using telehealth would be an extremely cost effective means of addressing their preventable health risks and conditions.

The presentation will conclude with a projected cost to Medicare of providing the same access to Medicare as city Australians. It will call on the National Rural Health Alliance and its partners to advocate for unrestricted Medicare rebates for GP services into remote and rural communities.

Presentation | Paper
Jill Sonke

Arts in health Arts in health

The University of Florida Center for Arts in Medicine Interdisciplinary Research Lab: arts and health communication and the arts and community health
Biography

Jill Sonke is director of the Center for the Arts in Medicine at the University of Florida (UF) and Assistant Director of UF Health Shands Arts in Medicine. She serves on the faculty of the UF Center for Arts in Medicine, and is an affiliated faculty member in the School of Theatre and Dance, the Center for African Studies, the STEM Translational Communication Center, the One Health Center, and the Center for Movement Disorders and Neurorestoration. Jill is an Entrepreneurship Faculty Fellow in the UF Warrington College of Business, serves on the editorial board for Arts & Health journal, and directs the national initiative, Creating Health Communities: Arts + Public Health in America. With 25 years of experience and leadership in arts in health, Jill is active in research, teaching, and international cultural exchange. Her current research focuses on the arts and health communication, the arts in public health, and the effects of music on cost and quality of care in emergency and trauma medicine. Jill is the recipient of numerous arts, public health and entrepreneurship awards and over 150 grants for her programs and research at the University of Florida.

Presentation
Evelien Spelten
How effective are interventions to reduce violence against health care workers?
Biography

Dr Evelien Spelten is Regional Research Coordinator and Senior Lecturer Public Health at La Trobe University. She is based in Mildura. Her research interests in health sciences are driven by curiosity and by the aspiration to connect research and practice. Her move from Amsterdam in the Netherlands to rural Mildura in Australia, sparked an interest in rural health and wellbeing and issues around equity. With a background in organisational psychology, her focus is on health services and quality of care. In collaboration with local and regional community partners, she is involved in several research projects: palliative care for terminally ill patients, cyber bullying, rural male adolescents’ gender identity development, water and wellbeing, and violence against health care workers.

Abstract

Introduction: Violence against health care workers is a major worldwide issue. It has relevance in all workforce settings, whether they are rural, remote, or metropolitan. It is estimated to affect 95% of workers and is an enormous risk for workers and for organisations.

No workplace is immune to workplace aggression, however some are at higher risk than others.

An example of a higher risk workplace is an ‘uncontrolled’ workplace. A controlled workplace is a predetermined work area, such as the emergency department or a hospital ward. In contrast, an uncontrolled workplace is a work space where the healthcare workers must adapt to suit a more dynamic environment. Examples of healthcare workers who operate in an uncontrolled environment, and are at a higher risk, are paramedics, midwives and remote area nurses.

In the past 15 years many interventions have been launched to prevent and minimise workplace aggression. However, little is known about how effective these interventions actually are in reducing workplace violence. The aim of our systematic Cochrane review is to find evidence on the effectiveness of organisational interventions to prevent and minimise workplace aggression against healthcare workers.

Methods: Using the Cochrane Collaboration guidelines, we are conducting a review to find evidence of the effectiveness of interventions. A systematic literature search will identify relevant published and unpublished randomized control trials (RCTs) and controlled before and after studies (CBAs) from nine international databases.

Results: Our review is in progress. To date our results point to the following:

  • There are very few studies evaluating the effectiveness of interventions to reduce workplace violence.
  • As a result, there is little evidence of the effectiveness of current interventions.
  • Interventions that have been researched are often restricted to controlled environments.
  • Examples of these interventions are sedation and seclusion.

Discussion

  • Health care workers in rural and remote areas may be at higher risk of violent incidents at work, especially if they work in uncontrolled environments.
  • There is very little evidence of effective interventions in these environments.
  • These results need to being discussed with regards to their implications for rural practice. How can we prevent and reduce violence in rural and remote settings?
Presentation
Evelien Spelten
Writing for publication and meet the Editors of the Australian Journal of Rural Health
Biography

Dr Evelien Spelten is Regional Research Coordinator and Senior Lecturer Public Health at La Trobe University. She is based in Mildura. Her research interests in health sciences are driven by curiosity and by the aspiration to connect research and practice. Her move from Amsterdam in the Netherlands to rural Mildura in Australia, sparked an interest in rural health and wellbeing and issues around equity. With a background in organisational psychology, her focus is on health services and quality of care. In collaboration with local and regional community partners, she is involved in several research projects: palliative care for terminally ill patients, cyber bullying, rural male adolescents’ gender identity development, water and wellbeing, and violence against health care workers.

Abstract

Thinking about publishing research on rural and remote health?

Want to know more about peer review and the pathway to academic publication?

Interested in becoming involved with the journal as a reviewer or in some other capacity?

Would you like to explore ways to increase the impact of your research and publications?

Meet the editors of The Australian Journal of Rural Health in a special session designed to clarify publishing procedures and improve your chances of being published in our journal and others.

Editor in Chief Russell Roberts and Associate Editors will be available to discuss the editorial policies and priorities of AJRH and answer your publishing questions.

New and established authors are welcome!

Now in its 25th year of publication, AJRH provides research information, policy articles and reflections related to health care in rural and remote areas of Australia.  Since its inception, AJRH has contributed significantly to the publication of research reports and expert opinion on rural and remote health.

Presentation
Marianne St Clair

Peer-reviewed paper Peer-reviewed paper

A collaborative approach in remote Aboriginal communities: why has telehealth worked in the Laynhapuy Homelands?
Biography

Marianne St Clair completed a BSc (biology and computer science) and Honours at Flinders University of SA (FUSA).  She then taught and participated in research at the University of Adelaide (UoA) and FUSA for approximately nine years, specialising in whole organism biology, ecology (marine), animal behaviour (non-human primates), and biostatistics. Marianne then ran a consulting company specialising in environmental consulting, information system analysis, design and implementation. In 2002 she took up the position of Executive Officer for the Primary Industries Training Advisory Council, overseeing the national training package development, supporting industry development and training solutions for primary industries. She was an active member of the Indigenous Mining and Enterprise Task Force. Marianne then worked with the Cattle Industry, Meat and Livestock Australia, Teas Bros and the Camel Industry to establish a large abattoir in the Top End. She has also worked with the Forestry and Forestry Products Industry to establish forestry-based enterprises in remote Indigenous communities and consulting work for Chinese companies.  In 2016 she commenced work as a researcher with the Northern Institute, Charles Darwin University, and has worked collaboratively with a team on a number of projects, including expanding access to telehealth in remote Aboriginal communities.

Abstract

Aim: The aim of the project was to demonstrate that telehealth could be successfully done with good quality reliable satellite internet for three very remote communities.

Setting and participants: This project was a collaboration between the Northern Institute (Charles Darwin University), Laynhapuy Homelands Health Service (LHS), Aboriginal Medical Service Alliance NT, eMerge, Broadband for the Bush and Telstra Health and was supported by a Regional Economic and Infrastructure grant. The three communities chosen by the Laynhapuy Health Service for telehealth implementation were Gan Gan, Yilpara and Wandawuy (that is, their most remote sites).

Design and methods: A collaborative approach was taken with project consultation, development and implementation to demonstrate the value of telehealth and video conferencing and maximize benefits to the community. Three Gilat satellite dishes and twelve months uncontended internet connectivity were deployed in three very remote East Arnhem communities. (Contention in network terms refers to the number of people on a network link competing for the network’s limited resources. An uncontended network is one where only users from one organisation have access to the bandwidth on that private network.)

Results: LHS staff now regularly use video conferencing cameras and software for telehealth. Diagnoses are being aided by less formal modes of video conferencing rather than scheduled appointment driven video conferencing tools (St Clair et al, 2018; St Clair et al., 2019). For example, clinicians are using Facetime, smart phone camera optics and digital capabilities for triage and diagnostic assessment. Anecdotally, video conferencing has proved to be a “game changer” in remote Indigenous health service delivery for many reasons, including the facilitation of joint and more informed decision making by patients, families and clinicians, and the patients being able to see familiar faces. Using videoconferencing has also resulted in more accurate assessments for evacuations and acute care retrievals, provision of access to a wider range of services, provision of training and direct supervision of staff including registrar GPs (St Clair et al., 2019). Additionally, savings to the patient travel for the last 6 months of 2018 are estimated to be in excess of $13,000 per month (St Clair & Murtagh, 2018a).

Conclusion: Face-to-face consultation via video conferencing and direct supervision and observation of patient examinations are delivering better health outcomes for patients (St Clair et al, 2019). By showing patients and families pictures and videos from the internet, the supervising GP can demonstrate clearly what the problem is, the treatment required and opportunistically provide education for both patient and remote end clinicians (St Clair et al., 2018). Additionally, telehealth implementation has facilitated timely joint decision making for remote Aboriginal people resulting in a more positive patient outcome and crucial clinical procedures being done more expediently therefore improving the probability of survival (St Clair et al., 2019).

Presentation | Paper
Heather St John
Have your say in how the Medical Research Future Fund can transform rural health outcomes
Biography

Heather St John is the Director of MRFF (Medical Research Future Fund) Initiatives at the University of Melbourne. Heather’s team supports researchers and clinicians at the University and partner organisations in the Melbourne Academic Centre for Health, particularly in the development of large collaborative research initiatives aligned to MRFF objectives. Heather has an extensive track record in supporting the translation of new health technology innovations from research phase through to adoption; fostering cross-disciplinary collaborations; developing research and commercialisation strategy for consortia; and securing multi-million dollar funding to support these endeavours. Prior to joining the University of Melbourne in late 2017, Heather was the Chief Operating Officer, Monash Institute of Medical Engineering, and was responsible for establishing the partnership of five hospitals, three medical research institutes and the University to accelerate clinician-led medical technology innovation. Heather commenced her research career as part of the international team that developed the world’s first extended-wear contact lens. She later commercialised a novel biomaterial that has been used in millions of life-sustaining devices. Heather has also had roles as Director of Industry Engagement at Monash University, Director of AorTech Biomaterials Pty Ltd and Group leader at CSIRO.

Abstract

Clinicians, researchers and community representatives are encouraged to attend this workshop and assist the Alliance to develop its rural research priorities and explore ways of ensuring effective translation of research outcomes from the MRFF have clear benefits for rural Australians.

The $20bn Medical Research Future Fund has been launched with $1.6bn expected to be spent in the first five years.

The program has some unique features that hold significant promise for transforming the health of rural and remote communities.

The key stated aim is through strategic investment to transform health and medical research and innovation to improve lives, build the economy and contribute to health system sustainability.

The underpinning principles are clearly geared to ensuring the fund is responsive to unmet health needs and promoting national focus and collaboration. Translation of the research for patient and community benefit is clearly a key requirement.

The opportunity exists to clarify the importance of effective engagement through MRFF and the research bodies to ensure the 7 million people living in rural Australia benefit. 

In this process the role of the National Rural Health Alliance would seem pivotal.

The engagement needs to be able to:

  • Provide a clear understanding of the major research questions and priorities for rural and remote communities. The Alliance is in a unique position to facilitate and describe these priorities to both the MRFF and participating Universities and Institutions.
  • Articulate and potentially develop a pathway in both the design of the research and in the translation of the research into rural and remote health settings and practice.
  • Ensure that all of the research undertaken through the MRFF includes a thread involving consideration of rural and remote health and communities.

The MRFF and the NRHA are already engaged through formal consultative processes and some part of these questions are already receiving a degree of attention.

Presentation
Caroline Stevenson
Mental health service delivery in rural and remote regions: can telecare partnerships meet the needs of children?
Biography

Dr Caroline Stevenson is the Manager of the Clinical Psychology Team at Royal Far West. Caroline has extensive experience in clinical, research and teaching roles at, among others, Macquarie University, Sydney Children’s Hospital, The Prince of Wales Adolescent Service and The Northern Beaches Adolescent Service. Caroline graduated from the University of Sydney, with a Masters degree and a PhD in Clinical Psychology.

Abstract

Mental health service delivery to children in rural and remote areas faces many challenges including attracting and retaining staff, continuity of care, poor accessibility and limited consumer choice.

Royal Far West has teamed with a number of different service partners in health and education seeking solutions to meeting the mental health needs of children in rural and remote areas With improvements in internet capacity across Australia, internet based therapy has become a viable mode of delivery for mental health services. Royal Far West has developed a number of innovations in telecare including mixed mode service delivery, gamification of therapy resources and introduced interactive, child friendly therapy packages to ensure children are offered engaging and stimulating interventions.

A randomised controlled trial of telecare vs face to face demonstrated that the outcomes for internet based therapy are comparable to face to face delivery. Consumer satisfaction evaluations have demonstrated that the services are well received, and in some instances preferred. Further, our service partners have been able to provide mental health services to those children who would not otherwise be able to access services.

To conclude, internet based service delivery models are safe, effective, consumer friendly, accessible and provide service choice to children in rural and remote regions of Australia.

Presentation | Paper
Deborah Stockton
From pilot to state-wide scale up: extending Tresillian’s rural reach through partnership
Biography

Deborah Stockton has specialised in the field of child and family health nursing for over 20 years, with positions including Clinical Nurse Consultant, Director of Clinical Services and Community Services Manager in rural Victoria. Deborah holds a Masters in Adult Education and has held the position of Director Professional Development, Clinical Education and Research with Albury Wodonga Health. These positions have enabled Deborah to develop initiatives in partnership with other organisations, promote interprofessional practice and develop organisational research capacity building programs. Deborah is a PhD candidate at University of Technology Sydney, with her area of research focusing on rural service development and the adaptation of service models for diverse settings. As Operational Manager Regional Services with Tresillian Family Care Centres, Deborah has operational management responsibilities for Tresillian’s regional services and leads the organisation’s regional service development, working collaboratively with rural health service partners to design and develop innovative services to address the needs of families in rural and regional areas.

Abstract

The first years of life are vital to the positive trajectory of the life course and health outcomes of individuals, their families and communities. However, families in rural and regional New South Wales face challenges to accessing support during those crucial early years. The NSW Rural Health Plan (2014) emphasises the need for service development in rural and regional areas in light of poor health outcomes for families in Rural NSW impacted by geographic isolation, socio-economic disadvantage and drought/climate change.

Tresillian is Australia’s largest specialist child and family health organisation, providing support to families experiencing difficulties in the early parenting period in NSW since 1918. The organisation has evolved as it has responded to current community needs, while maintaining a focus on child wellbeing and building resilient families and communities. This has been achieved through a service model which addresses the social determinants of health, engaging with families in the critical early years and working collaboratively with parents to build confident, resilient families and communities.

The Tresillian Family Care Centres model provides a base from which a range of services are provided including comprehensive assessment and consultation for the management of a range of early parenting challenges, home-based services, evidence-based group programs, perinatal mental health services and an early intervention home visiting program for families experiencing complex vulnerabilities impacting on parenting capacity. Telehealth consultation services and satellite services to surrounding communities further extend the reach to geographically isolated communities.

Core to the service model is the provision of professional development and clinical support to enhance the capacity of primary-level clinicians working with families in the local area. The foundation of the model are the partnerships with the Local Health Districts, enabling the effective delivery of integrated care for families.

This presentation will describe Tresillian’s journey and learnings from the commissioning of two pilot rural services in Northern and Southern NSW to the scale-up of Level 2 specialist services across 8 locations with broad reach throughout rural and regional NSW in partnership with Local Health Districts from the coast to the far west of the state. Partnerships and integration into local service system networks has been integral to the model achieving a seamless service response for families in the early parenting period, appropriate to the level of need and complexity.

Presentation | Paper
Sharon Stokell
Pop-up women’s health service for rural and remote communities
Biography

Sharon Stokell started in administration over 30 years ago and has worked in a diverse range of work environments, including hospitals, general practice, allied health roles, and now for True as the Business Manager of Clinical Services and Operations. This is a role that has grown significantly over the last three years and Sharon finds her passion for a challenge, and the daily utilisation of her management and counselling skills the reasons she enjoys this work in the not-for-profit sector. Sharon's background is economics, business and practice management, psychology and mental health and her work has taken her across the state. Apart from her work at True, she also has a successful private psychology and mental health practice in Toowoomba. This client work continues to feed her drive to help others with the stressors that are experienced across all facets of the lifespan. Many areas she counsels in also correlate with the reproductive and sexual health work that True undertakes in the clinical setting. Sharon thrives on a challenge and is very lucky to be a part of the amazing team at True who constantly challenge, support and drive her to do better each day.

Abstract

Learning objectives

  • Development of a sustainable Women’s health service in rural and remote regions.
  • Community participation in implementing a new health service and the resulting community benefits.

Activities and methods: Many rural and remote Qld communities have no women’s health services providing consultations across areas such as cervical screening, complex contraception, and management of gynaecological and sexual health issues. Problems can be complex and the need for confidentiality very high. Many women need to travel over 1000km to see a clinician for a consultation and for subsequent treatment.

True Relationships and Reproductive Health (True), a specialist in reproductive and sexual services, supported by CheckUp and the Department of Health, has implemented a Women’s health Service for Queensland’s rural and remote communities where no such service exists.

Outcomes and results: From commencement of just six pop-up clinics True is now providing pop-up services to fifteen communities. Community support has been phenomenal with one community fundraising to ensure all equipment needs were met in the local clinic. Appointment scheduling is supported at the local level and True’s clinics are always booked out well ahead of the visits.

Clients appreciate the confidentiality which the service provides, while still being delivered locally. Clients report that they now undertake these important health checks, which in the past had been neglected due to the travel and costs involved.

True’s pop-up clinical model has proved to be cost effective, sustainable service with 100% of clients reporting that they are highly satisfied with the service.

Conclusion: The health benefits of proactive management mean that chronic disease can be prevented and less ill health days reported. Delivering a service into a local community overcomes reported barriers and ensures access to appropriate care for community members. Naturally, this supports the wellbeing and economic benefit for both the community and the individual.

Paper
Lynne Strathie
A carer's reflection on navigating the NDIS in the Northern Territory
Biography

Lynne Strathie has a background in education, at mainly secondary school and college level, but also early childhood, special needs and adult education. She has a million-dollar child: 82 hospitalisations and counting. Being fair minded and ethical Lynne believes that we should accept responsibility to give back to the community. Therefore, she has a volunteer life focused on advocating for those with disabilities, family carers as well as consumer health. Her academic background includes Dip T, B Ed,Master Applied Ling, Master Rehab Counselling, Vet CertIV. Most famously, Lynne is a single mother to three adult children and a family carer. Her passions include family life, advocacy, gardening, in particular growing orchids, and having a chat.

Abstract

My journey is very challenging and confusing. This, despite me feeling well informed, intelligent, with many tertiary degrees and a lifetime of experience as a family carer.

The National Disability Insurance Scheme has evolved from a ground swell of activism by carers in Australia prior to 2010.

There was bipartisan political support for the system. High profile people were employed to advance the cause. We had even discussed the enormity of the costs to the Australian taxpayer and proposed a marginal proportion of a percentage point added to taxpayers Medicare levy. This was considered a very fair and gentle way of sharing the economic burden. What would .01% of your Medicare levy be? We had cause to be full of optimism.

What has followed has been the development of an enormously complex system. Governments have committed significant resources in the creation of the NDIS to date.  Individuals and groups of people working together under the auspices of government. Organisations are working together. Success is the goal: the broader community at multiple levels seem committed to the same pathway. The outcomes for the NDIS is clearly appropriate levels of resources to support the health and wellness of the grass root clients: those with disabilities

Along the journey I have attended many seminars offered by various organisations to support carers navigating the system. Carers NT in collaboration with Carers Queensland, and I assume other state and Territory organisations, developed a folder full of informative publications. Carers NT ran a series of workshops, gently paced, with plenty of opportunity to ask for clarifications. The NDIS appears to have created an industry around providing information including stacks of publications followed by face to face regional forums aimed at supporting understanding of the publications. These forums were not exclusive to carers but were inclusive of anybody who may want to be well informed. Therefore, allied health professionals and, I assume, clinicians were welcome. So, with this extremely thorough approach, why the confusion?

This presentation explores some issues challenging carers that are anxiety producing. With comprehensive collaborative approaches, bipartisan support, and the very best will in the world why are carers complaining?

Heidi Sturk
Accessing evidence-based online mental health support
Biography

Heidi Sturk (BPsych Hons, MOrgPsych UQ) is the Deputy Director of eMHPrac (e-Mental Health in Practice) at QUT. Heidi delivers national training and support on digital mental health resources to allied health practitioners and service providers working with Aboriginal and Torres Strait Islander people. She has over 20 years' experience in applied mental health research. Her areas of interest include how to integrate digital technologies into health care, rural and remote health care practice, and wellbeing of health practitioners.

Abstract

Head to Health is a digital mental health gateway launched by the Australian Government in October 2017(headtohealth.gov.au). It links Australians to online and phone mental health services appropriate for their individual needs. Services and resources listed on Head to Health are delivered by trusted mental health service providers. They include free or low-cost apps, online support communities, online courses and phone services that are private and secure. Head to Health is not only helpful when seeking support for a mental health condition, it also provides information about staying mentally well. It is particularly valuable for Australians living in rural and remote areas who have limited access to mental health support.

Head to Health was developed in collaboration with the community, the mental health sector and the Department of Health. E-Mental Health in Practice (eMHPrac) is a government-funded project which aims to increase practitioner awareness and use of digital mental health. eMHPrac has been promoting Head to Health as part of their national promotion and training work.

Head to Health currently has over 380 digital mental health resources from Government funded organisations. These resources are from trusted organisations to ensure both health providers and people with mental health needs and their carers have access to the best information online. This presentation will demonstrate the site and explain useful features. It will also present details of promotion activities, usage figures since the launch and feedback from training participants and site surveys.

The availability and diversity of digital mental health is continuing to grow and has an important role within our mental health service provision model. The establishment of a gateway is a significant step which allows Australians to have quick and easy access to online and phone based mental health support. The website will continue to evolve based on user feedback and website analytics.

Presentation
Allan Sumner

Arts in health Arts in health

Indigenous art and health: ‘arts as practice’
Biography

Allan Sumner is a Ngarrindjeri – Kaurna – Yunkunytjatjara man, a renowned Aboriginal artist and is the Director of ACA Studios and Art Gallery, Aldinga Beach SA. Allan has had over 20 years’ experience as an Aboriginal health practitioner. Allan is an Associate Lecturer for the Poche Centre at Flinders University, where he teaches across health sciences, including medicine, social work and other allied service faculties.

Abstract

Strengths-based dialogue of health as a ‘decolonisation’ process. Indigenous knowledges as scholarship through teaching and research.

Join Allan as he explores practical methods of engaging people in object-based learning (OBL). Firstly, he will discuss cultural sensitivities when working with people; ways to create an environment for cultural expression; how to build and nurture a connection to self, staff, students, country and culture.

Secondly, Allan will also talk about how Flinders University are embedding Indigenous knowledges across the academy. He will highlight some of the innovative ways in which contemporary Aboriginal art is currently being used in teaching and research efforts to bring about better health outcomes for Aboriginal people. The presentation positions Indigenous knowledges, culture front and centre, and argues for a strength-based approach to Indigenous health through decolonisation. This presentation seeks to extend Indigenous scholarship though the lens of ‘arts as practice’.

Presentation
Helen Swain

Arts in health Arts in health

Caring for carers who care for people with dementia
Biography

Helen Swain is a poet, performer and retired teacher from Hobart, Tasmania. Helen performs her poetry in a kitchen show, Tart Words and has been invited to cook and perform in local halls, community centres, studios and kitchens around Tasmania. She has performed in local amateur and professional theatre in Hobart and as spoken word improvisor has performed in Hobart, on mainland Australia and a short season in Berlin and Paris. She is currently writing and working with Tas Performs to produce a one-woman show depicting the dilemmas of life as a carer.

Abstract

'Who Cares', is a one woman show that explores some of the issues facing sole carers looking after an elderly relative at home. Clara, the protagonist discovers her own anger, frustration and guilt as she cares for her beloved mother and has to come terms with the expectations of self, society and family. The play also explores the gap between real and theoretical systems of support and the language that all too often covers up the day to day truths of caring.

Lindy Swain
Can psychology student placements improve access to mental health services for Kimberley peoples?
Biography

Lindy Swain is the Director of the Kimberley Rural Health Alliance (KRHA). Lindy and her team are establishing innovative student health placements across the Kimberley, in an attempt to improve recruitment and retention of workforce, and health outcomes. The KRHA goals include to increase health students’ understanding of rural and remote health inequity, to improve cultural safety practices of health professionals and students, to increase the skills and attributes needed by health professionals for remote practice and to support research into rural workforce and innovative models of care. Lindy‘s particular area of interest is working with Aboriginal and Torres Strait Islander people to assist with medication management, optimising treatment and outcomes. Lindy’s PhD thesis was entitled 'Improving medication management for Aboriginal and Torres Strait Islander people through investigating the use of Home Medicines Review'.

Abstract

The numbers of suicide and self-inflicted injuries in the Kimberley are amongst the highest in Australia and are over 7 times higher than the state average. They are the leading cause of death for Kimberley youth between 16 and 24 years of age. Within the remote Kimberley region of Western Australia, of the 15% of adults who have a diagnosed mental health problem only 8% have accessed mental health services. Despite the high need for psychology services, there are very few clinical psychologists in the Kimberley and referred patients are on long waitlists

The Kimberley Rural Health Alliance (KRHA), a newly established University Department of Rural Health, is collaborating with Murdoch University and a number of local organisations to support clinical psychology students to expand the delivery of mental health services in the Kimberley. As there are very few accredited psychologist supervisors working in the Kimberley region it is very difficult to organise clinical placements for psychology students. The KRHA cultural security officer provides students with cultural training, mentoring and support.

KRHA is piloting a program, in which clinical psychology students are placed within organisations that do not currently have psychology services, such as an Aboriginal Drug and Alcohol rehabilitation centre and an Aboriginal Community Controlled Health Service. Psychology students are integrated within the primary health care setting, often locally supervised by the senior Aboriginal health workers, whilst also receiving remote supervision by videoconference from a clinical psychologist at a city based university. This is a unique and innovative, non- traditional way to supervise clinical psychology students, which allows psychology students to be placed in culturally safe settings where there is client need.

There is an interprofessional emphasis in these placements, in which students work together with local health workers to develop and implement psychological services appropriate to the needs of the community as well as enhancing their own learning and practices in culturally responsive ways. This may include undertaking assessments, as referred by GP’s and health workers, and implementing evidence informed interventions with individuals, families or in groups, that are adapted as appropriate to the local context, with input from local services.

This clinical psychology placement program is currently being evaluated for student and client outcomes and community impact. This presentation will share evaluation data and outline the challenges and some potential solutions to increasing psychology services in remote Australia and enhancing cultural responsivity in psychology training programs.

Presentation | Paper